Provider Demographics
NPI:1114168853
Name:CHARLESTOWN PHYSICAL THERAPY AND HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:CHARLESTOWN PHYSICAL THERAPY AND HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:E
Authorized Official - Last Name:MICHAUD
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:401-364-2020
Mailing Address - Street 1:PO BOX 1091
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02813
Mailing Address - Country:US
Mailing Address - Phone:401-364-2020
Mailing Address - Fax:401-364-2030
Practice Address - Street 1:3939 OLD POST RD.
Practice Address - Street 2:
Practice Address - City:CHARLESTOWN
Practice Address - State:RI
Practice Address - Zip Code:02813
Practice Address - Country:US
Practice Address - Phone:401-364-2020
Practice Address - Fax:401-364-2030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-10
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT01887225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty